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Home My WebLink About022-1073-50-120 P3 P3 C F3 fD C!1 o y O 3 m c tv (D ~%j C-4 cD 'D - C. O v at W P) ct t't F-' z O `2' s 1 ;K P 0 0 N 0 p co CCD K0)) NCl `C ( H N 7• 3 fCDD l~D v y " 0 rl tJ~ d Z Z H U' L p I c 3 (D CD = 0 CD W o a > 7 CD o 0 'O m e ro w 0 D N t7 7 0 m U) z D CD t' ~ W o N a o _0 C- 1 IV CD o p It 3 10 0 N N (V t CD CD -4 00 H CL - Q 8 O O 000 OD N 0 c 4 -4 U) r! cr p H x < N z ~y~,~ • ` 00 Cl~ 0 2N o v c co co) co) o D ~ M P~ 3 `D g d -4 ~rt UA a D D o 0 ~ I c O ~ a o. lr • X O c I w m z CD -1 y A Z 0 =h A Z O y G ' Z ~ N N p m z ;o c 3 a o Z ~CC N .c A CA) d ~p 0 m fD. 7 D 3 7 3 - n (D a C'7 M Q -0 CD m CL , n EL O °o .o OZ a a ~ y dO. CD _ID A O y 0oo oo CL a x ~ ° A a - V fD (OD o 3 0• c CL (D 01 A CL Z -4 m cc) Z a O 0 cc 13, > ! N o y m N cc -,a rr qb I ~ C ~ a m 3 A 0 ti CD v q O ~p ya p ti i Parcel 022-1073-50-120 02/01/2006 11:21 AM PAGE 1 OF 2 Alt. Parcel M 26.28.18.405A-12 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/23/2005 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - ROBEY, PATRICIA E PATRICIA E ROBEY 1334 EVERGREEN DR RIVER FALLS WI 54022 I Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1334 EVERGREEN DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 7.738 Plat: 4776-CSM 18-4776 022-04 SEC 26 T28N R18W NE NW EXC CSM VOL 2/489 Block/Condo Bldg: LOT 2 & EXC CSM 18-4776 NKA CSM 18-4776 LOT 2 (7.738 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 26-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/01/2004 767457 2607/105 WD 06/22/2004 766657 2601/340 EZ-1 06/23/2003 766740 18/4776 4776 07/23/1997 1129/352 WD more 2005 SUMMARY Bill Fair Market Value: Assessed with: 143755 283,400 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.738 90,000 196,500 286,500 NO Totals for 2005: General Property 7.738 90,000 196,500 286,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 08/22/2005 Batch 05-1 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Ap 766740 2 7 2005 VOL 18 PAGE 4776 wwLsw- RfiGISTER OF DEEDS ST. CEIVEDxF RCO wl RE -kECORD SURVEY MAP 06.23.2e04 11 :50AM LOCATED IN PART OF THE NE1 /4 OF THE NW1 /4 OF CERTIFIED SURVEY MAP SECTION 26, T28N. R18W. TOWN OF KINNICKINNIC. ST. REC FEE: 13.00 COPY FEE: 3.00 CROIX COUNTY. WISCONSIN. PAGES: 2 SURVEYOR: PREPARED FOR: DOUGLAS J. ZAHLER ALLEN C. NYHAGEN S & N LAND SURVEYING, INC. 1334 EVERGREEN DR. 2920 ENLOE STREET RIVER FALLS. WI 54022 N1/4 COR. NW COR. HUDSON, WI 54016 SEC. 26 ---589°45'55"W 2603.39 SEC. 26 NORTH LINE OF THE NW1/4~ ` 2024.8T 578.52 SCALE IN FEET 1" = 100' MLA uDLL QVVC D dGQG']U~ _O~GJC~D C3~'I G?~Q55.441~G.3 ~ ~ 100 0 100 889°59'58"E 390.41' m •OaD 2 z 'O > MOUND (0 ~ W SYSTEM O N~ An N ~ do O J i ap m 65 m Z m i \ tD ~ppjq a~ • ry" ion i~-g irL1, wN e Q 1 N p n ;\,oo GARAGE LOT 2 to C7 I wava d" JUN A ~7 ZOO4 O I ~ -'s w ~~m l 1 ° o A 5 \ o \ 7.738 ACRE ~ of (337.063 SO. F V % INC. Z m \1 0 jQil 7.517 ACR S i o 1 \ o (327.441 SO. FT.) 1 EXC.R/W \ I `fi'r ~I QO -~1~ N4201 0'20"W 's IQ LEGEND 136.08' I SHED 1 c~b I 66' WIDE FOUND ALUMINUM I ACCESS EASEMENT RECQ OL L g 6q IN COUNTY SECTION I V CORNER MONUMENT 66' PG0 OUTSIDE 13 I N 00 FOUND 1" DIAMETER IRON PIPE SET 1" OUTSIDE DIAMETER I iZ BY 18" LONG IRON PIPE, I WEIGHING 1.13 LBS. PER LINEAR FOOT ° (a x - EXISTING FENCE I A- OF WISL.Oy I z N DOUGLAS J. ~Z V - -JIM 66' 171 * ZAHLER .V V S-21 O ~ @J I N H D G\W ilk O I~lno^~ I t o i p u I I a I o ' o ~ 66' S89°10'13"W 288.06 s607 EVEROREEN DRIVE o w o, 889°26'20"W 288.47 E SOUTH LINE OF THE NE1/4 OF THE NW1 THIS INSTRUMENT DRAFTED BY. WILLIAM KANE JOB NO. 6091-05 DATE: 05/04/2004 REVISED: 06/21/2004 SHEET 1 OF 2 SHEETS Vol 18 Page 4776 CO - • S Ek N LAND SURVEYING • HUDSON , WISCONSIN 54016 D 00 (715) 386-2007 AUG 161.995 N Nome Allen and Linda Nyhagen Address 1225 C . T . H . "A" ST. CROIX COUNTY Hudson, WI 54016 SU VEYOR' RECORD Description Part of the NE1/4 of the NW1/4 of Section 26, T28N, R18W, Town of N Kinnickinnic, St. Croix County, Wisconsin. (Futher described on Sheet 2). NW Corner of N Section 26 3 r N r N 0 ~ °o~'- S89°04'09"E S89°04'09"E 400.00' 1544.39' w ~ _ Septic Well ~g Mound 3.95 o,n r N Ln CD Ln 0 o Acres' House o°a O O M M C Z V) Garage N 9 w .J O 139.34' I 194.63' N89°04'09"W I j N89°04'09"W 3 Z N I ~ I I j 4- 0 3 1 c ~V1 U~ U 1 I r 0 I I c 3 N N I I U 00 00 n I•L1 n U W Iqi N p~ 3 W 1 1 ^ V I '0 M NI M = f'X( o ` N N IW (V O Z N 1 I I I 6611 I I I ~ I I I 1 W1/4 Corner of Section 26 EVERGREEN JT8'5°5714 DRIVE 3W State of Wisconsin County of St. Croix ) ss. SCALE OF MAP - I INCH : 200 Feet is Allen C. Nyhagen , registered Wisconsin Land Surveyor,do hereby certify that on _ May 5th 19 95 , I surveyed the above described and mapped property according to the official records and that the accompanying mop is a correctly dimensioned representation to scale of the boundories,that all buildings and improvements lie wholly within the bou9dq~y lines, and that no encroachments by adjoining owners appear from said survey. ~fr00 Map No. 95-45 ALLEN C. Drawn By F. B. NYHAGEN S-1407 HUDSON, r- WIS. ~r'QQ•r NO su R~ ~6®~'~ ~~~~iso+aa,sobe Parcel 022-1073-80-000 02/01/2006 11:16 AM PAGE 1 OF 1 Alt. Parcel M 26.28.18.406A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - NYHAGEN, ALLEN C & LINDA L ALLEN C & LINDA L NYHAGEN 2952 2 1/2 AVE NEW AUBURN WI 54757 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 37.500 Plat: N/A-NOT AVAILABLE SEC 26 T28N R18W NW NW EXC PT TO CSM Block/Condo Bldg: 14/3999 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1129/352 WD 07/23/1997 820/42 07/23/1997 578/343 07/23/1997 442/103 2005 SUMMARY Bill M Fair Market Value: Assessed with: 143758 93,000 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 37.500 94,000 0 94,000 NO Totals for 2005: General Property 37.500 94,000 0 94,000 Woodland 0.000 0 0 Totals for 2004: General Property 37.500 1,500 0 1,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 D CERTIFIED SURVEY"MAP 34401 F.-L. CAHILL sT. CROiX COUNTY ~RyEYOR' RECORD Part of the Northeast 1/4 of the Northwest 1/4 of Section 26, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. = DUE WEST `o %9 581.97' N 1/+(-OR. 5 EC. 26, O :2 W NO ~s o 728N, R18 VV Ll Ln } O Ln APPROVED z `4, _ 0 C T i g 1977 _ z do LO cn 18.14 CO ST. CROIX - :7UNTY < LL fp ACRES L'j O COMPREHENSIVc ...::S PLANNING W 0 o AND ZONING COMMITTEE co V z - M O W Lj 0 ch U Ji - C\1 SCALE I = 3 d J APPROVAL OF THIS MINOR SUBDIVISION OQ' I C6 DOES NOT. MEAN APPROVAL FOR BUILDING SITE OR SEPTIC SYSTEM. REFER TO H62.20. 8 6 18.71' N 89°56'4 E TO WN ROAD O Indicates l" x 24" iron pipe weighing 1.13 lbs/ft set. Description: That certain parcel of land located in the NE 1/4 of the NW 1/4 of Section 26, T 28 N, R 18 W, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows; Commencing at the N 1/4 corner of said Section 26, the f61nt of Beginning of the parcel to be herein described, ( Bearings referenced to the North line of the NW 1/4 of said Section 26, assumed due West ) thence due West a distance of 581.97 feet; thence S Oe 45'54"W a distance of 1316.86 feet; thence N 89"56'41; E a distance of 618.71 feet ; thence N 00' 09' 57" E a distance of 1315.81 feet to the Point of Beginning of the parcel described above, contain- ing 18.14 acres, more or less, including the South 33 feet thereof presently b®ing used for Town Road purposes. State of Wisconsin) County of St. Croix) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, F..-L'.Cahill, I have surveyed and divided the lands shown hereon according to official records, Chapter 236 of Wisconsin Statutes, and St. Croix County Ordinances; and that the map and description shown hereon are a true and correct representation thereof. Dated: 14 September 1977 Vol. 2 Page. 489 Certified Survey Maps James L. Murphy \\\jXarrrrnrfrrr►►►rrri/Z St. Croix County Records 3 4 gistered Land Surveyor N C St. Croix County, Wisconsin * FIL ED ' JAMES L. OCT N-11URPHY 1 0, 0 241977 3 rte; S- 1 0 4 2 _ 44614kr C~*kILL RIVER FALLS, : •C i^ ; ~+aGri irJ;. WISC. OT ro I'll ?7 00d IZ16 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.OPBOX 7969 BUREAU OF PLUMBING i MADISON, WI 53707 TANK REPLACEMEN T NW NW, 26f2$f1$ ❑CONVENTIONAL El ALTERNATIVE State Plan I.D. Number: 11f assigned) Town of Kinnickinnic El Holding Tank ❑ In-Ground Pressure D Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: John Reis Rt . 2, River Falls, WI 54022 -;Z al lkX BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.r CST REF. PT. ELEV.: Name of Plumber, ,J MPRSW No. County: Sanitary Permit Number: f ` Thomas Wan 3231 St. Croix 92475 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCV KING COVER PROVIDED, PROIDED: DYES ONO DYES ONO H BEDDING: VENT DIA.: VENT MATL.: HIGH WAT q NUMBER OF ROAD: PgOPERTV., WELL: BUILDING: VENTTQFRES ALARM: LINE: AIR INLET. OM DYES ONO DYES ONO FEET FR INEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER, WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO OYES ONO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) PU DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH: IND. OF DISTR. PIPE SPACING: COVER INSIDE DIA. #PITS LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH DIMENSIONS RAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER: ELEV. INLET. ELEV. END: PIPES. FEET FROM LINE: AIR INLET. NEAREST--e- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL COVER' XTURE'. PERMANENT MARKERS. OBSERVATION WELLS DYES ONO DYES NO JDEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.: CIA ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED DYES NO YES ONO COMMENTS: PERMANENT MARK ERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: 1BUILDIG: NFEET FROM LINE: DYES ONO DYES ONO NEAREST x-03 ~S I.2S I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) i INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed puriper,whenever necessary,.usuallyevery.2- to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; I!. Type of building or use served: It public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. -..-----------------------------------------------------------------------------••------------------7--------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground.Water - included the creation of surcharges (fees) for a number o regulated practices which W'iscorsin's can effect groundwater. The surcharge took effect on July 1, 1984, All of the water that buried treasure iS, used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. ",ionios .:-;le-ted through these surcharges are credi'~ed to the groundwater fund adminis- rer by Ie :department of Natural Resources. These funds are used for , ors"coring ground- u. _u! dwater contamination in:-estigat!-)ns and est~blis€ mt nt 3 _;t. ndwds 3rcund%vater, s ttierfl+ protecting. ;iD-6398 (R.03%36i ; r Y' SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. *7630c? 7 -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES NO PROPERTY OWN R PROPERTY LOCATION :r6 him ft S '/a '/4, S T, N, R E (o KW PROPERTY OW R'S MAILING RESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME vex` CITY, STATE ZIP CODE PHONE NUMBER ❑ VILLAGE: r r ST RO LAKE OR LANDMARK a S a. p5~ TOWN OF 7 X/4 ;P1 _n le 11L OK den t?r 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. El New b. ~ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ❑ Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e,K Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ❑ Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet Private ❑Joint ❑ Public V1. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App Tanks Tanks lib Septic Tank or Holding Tank O6U C°s7 2'~-' 4 S LCD Lift Pump Tank/Si hon Chamber t f ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber' Name (Print): Plu Signature: (No tamps) MP/MPRSW No.: Business Phone Number: Plumber's A dress (Str et, Cityta e, GDde : Na I Designer: 6 C.J G Fa-S 5'40,~o S VIII. SOIL TEST INFORMATION Certified Soil TesteST) Name CST # s e Id air CST's AD ESS (Stre t, City, tat , Zip Code) Phone Number: D / ~ IX. COUNTY/DEPAR MENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater 11-15ate issuing Agent Signature (No Stamps) Surcharge Fee L-W Approved F-1 Owner Given InitialS/,00.00 Adverse Determination t0 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber 10 INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION r t THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit maybe renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Y2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundv+iater included the creation of surcharges (fees) for a number of regulated practices which Wiscorisin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ~reasure is used in your building is returned t{. the groundwater through your soil absorption system or the disposal site used by y::ur holding tank pumper. , Trig -~lf)i Yr ,.S ,fir trs t)rthese SJrc''satg~:S c:re credited t0 the gr OiJnWater addn"1 ;-tis_ i :re b; hie r, Aural F, ,sources. These funds are used for r or:to <; 0ur,f- > 1 v,,ate~, g,l ut iwr,± r -,Jn rnin,3 ic;z ir-astigatirms and establishment c sta.-tdat,ds ,a,c,,ndAat~. ~ i±'s wortl protecting. 53D-6398 (N.03/86) ILHF~ SANITARY PERMIT APPLICATION CO U" In accord with ILHR 83.05, Wis. Adm. Code SATE SANITARY PERMIT # ?69 Al -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ N PROP TY O NER ` PROPERTY LOCATION J6 C> '/a '4, s TN, R E (o W PROPERTY OWNER'S MAILING AD MR; LOT NUMBER BLOCKCK N R SUBDIVISION NAME ~a Ic ' is C~t`S CI , STATE ZIP rODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK S ❑ VILLAGE : e II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. Replacement c. replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ❑ Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑ seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet ❑ Private ❑ Joint ❑ Public. VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 4,260 S Lift Pump Tank/Si hon Chamber ❑ 1:1 1 ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plum er's Name (Print): Plumber's Signature: (No S MP/MPRSW No.: Business Phone Number: umbers Address (St 'el, Ci y, State, Z' ode): / Name of Designer: VIII. SOIL TEST INFORMATION G/ Cart' 'ed oil Tester (CST) Name CST # X zlz~ CST's ADDRESS, (Street/j AjMPA~ , City, tat ip Cod) Phone t,- t C L eg,~& ~ ~ Number. 11-4 9 Y/DEPARTMENT USE ONLY t/ /'vC IX. COUNT X❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No S mps) Approved ❑ Owner Given Initial S~rcharge Fee_ Adverse Determination ~ 9 ( 47 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03186) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber ea r Beofr/ce ]F19Z5~ se PAGE 29 Ave na/ eaymondNe sail d hb/man //4 H/no/d H- . /60 o /99 .7 M rc 767 Fv 'VE F /3o "9 se. Rq s 0 0~x W .Ic/e¢uae <LaQ Q 6 /¢rxa/Cr a/• Lubich a/ ~v0 u IcK/cr /sss7 /40.6 `c ~ J BO /z o • \l • • N 6 Go/dan S• Sher!// BO 70 ,Q°bert X. ""INE Moe//&r L•.o ,9rno/dF/ f Ge n/d ClQTG1S F)., ~~E/a;ne - R/ch re~ ND. • h gO Marcy//a go ~afh/ean Lueck b s ,Qa rtin •.v ,q/vin 's " ,Denson, yis7 Liss/ck as .R 3y TFp zr7 /ia a Peuben / F~{9 /bo eFa/ b 0 °9M.r/c. nai Fi.fschc //SSGG /bo. 1. F49 Z .:TRACT. • • 3/'e CTahnb Len `".71y`+.- fF7nne TRl'SCTS' r6rir¢,9 b .Ba/'bor¢ \ Colo/ 7hor7raS, 225 7 • - 7-homers, A Feyr/-eisen U.3 vv • eta/, eT 40• M ey SS ~Vy Men ~ Jr s• FredericrF ~ TE Lecnoid Fe~eO ~dy, ~n /bz.z9 6 u ✓ 40 ,R Kurf,3 Luc/%e /4o id E~' a~ / 40 Tue drY/ a /zc /sB5 Phi//iPRs Ma sen ak- : Bile/ Lease/i bs D ( ~ r 3 \ ~ r _ ,P P i5 ~ ~ f/awa r .LOP/' f C Q i7t5, Srx. U E ~ , _ 3'~ v Q o4 Cjcra/d Emho/ Lr a L 3 /2i a /i73 Z~Q / 41 n Potion b A 54 d/ Mo rya m °riy 0tl 4M h 1/anasse F e/'f d ~oras g G 0 @ ese wypa 9go~oncJ s P.no F 14o Wi a .sas T c. o • SJo th l~ r~ 7s33 • Q/tee ~i ~ O \ ~ .4 Dona/d f W ~ n Fu//e,~ ~'D9.63 ~ Howv y T s W !~y` ircl7- G/cr /ei' • Vu ~be 1s7 • • ss.s Trust Dane - Phi//i/zs 74 v erpa /4 5'~ ry • N 4D n oon Rsa~ Fo Tr/iy' 4 W W\~ cTohn U y, s Jo7 W 0 Karen ~r'oPa /f Cb es E 2O • \ Q~ /4-0 hrisfianson Lo/cowich W N b Qe/tC}~do • tl Thamas ? • Bo a o N /4/ to cL tu 3 2ios CTerr !7lbson, etux e, UR .sR. /ZO r- Fu//P! Emi/ 6P/ h J' `f etzx/ • ~b ax. a s0//ve e /9P-59 ~ Q 275 /4/ Ne/son ~ . A ; Go//rn- ~Tcrcobson q AVE. Danie/cT 9 h q oeeib V~~ /6fse~ °C w • 40 • E •G'a~/e- ro Ho d .se V C • 8 Finn ~j, p'9 V N so • 3 5 tl0 0 Xrumwiede L ` u 0 oae t o . v % /D . s. snv: a ,F q yF/QlPi a V N ° C'VANZ /b6B Ey t¢/~.% . v /2274 q ~ W /n y No a s 40 •~~00 3~ v R Thom/-+son ~0 vo p 47 fG f MI\ * . BO sri..r e f 7 -fi2A(,T N~ NN ti eS H "FDndrea Leo a Mar/in T ei KQf /)nom d 4022 9.uoc. Hr/drea K/ea,^ rQP. s 41 =to r a. ¢O k s'o Was 70 b/86 . Pec/iu/7.(ZPl ,¢0 4b a/n ~a V V Da Jrr- Cudd M~ 2/0.26 63 Lub- QM',`~~ FLUO. /neha ~ _ G'oun rx w 0 l- %Ch .78.2 73 ~ ,r roz /a ` ` Bo e ShWy G 9 3 B:e 32/ S LaMo/, 2 7 Mer/e s• 4 Ni cn Harry L. b l~e~nonH. 4 GKrea' Vernon f 0 /70.,5 .sr': 4O .~h Pas.Far go Eug a., Fi3a et 2 ac Sfan/e.~ /oo ~ o o. PeskQr'y Hcte/:ne 1 ~tty 79 y o RP Pesky/ dye cTo n c5wan ron P /s/sg Rose a: iNf 1' iJ !s /~unker' /2/.S On eSwe Son 20° w r Lars Davia s s n~ ,n v 40 C dd Sara. f f er'aF p Qom' • d e / • AYE 76.34 Bo /it • ~ \ v i//ia1nS 4l C ~ mil' G Py /.30 • noolsSy ,KT{~ns~j F'QU/ $ v v 8i verno~e ~ C ~ I~2vi QDe15/rG E ,-:mmh 27o 7 M`u.9Wa/.EeP o~: cu ry ekar=Y b a e Ovsak HaiHSECn T ~W • t • E ` ` • • !/e • /Bo • 'j M o • /40 l t.°Afe% V Gucr//e s y V. ~'/d 5 t c ~ non J .Ce// • ..ferrii : erne f.Pu Lee Lr~ !iii! Pecfiace.~ a `si AI 0--`f/. 60 ~r In C n,Be?o • .va~ ~/.A9B rPoc.E a d r!a pub.Cr Inc 40 ~PPIM4` ' p P P/E CE 11COUNTY ~SfCPaix G'ounty W.s. ` River Falls Grain Drying Grain Banking Medical Clinic, Ltd. HOIKKA IMPLEMENT INC. Bu lk Handling River Falls, Wisconsin HIGHWAY 63 NORTH Liquid Fertilizer 425-6701 BALDWIN, WISCONSIN 54002 Custom Grinding - Mixing I Ellsworth 684-4727 DEISS & NUGENT Medical Clinic FEED CO. Ellsworth, Wisconsin r Phone: 273-5066 273-5041 East Ellsworth, Wisconsin '54010 14 1 r f 1 i. • ~ - , , - . ` . r ry ,t: k APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CJ Owner of Property l Q Location of Property U d Section , T, N-R 8 W f r Township Flailing Address O V-1/, Z 6 Address of Site Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel ! GL Date Parcel was Created v.~,1c7,v Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes x No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) cehtti,6y that a t statements on thin 6onm are true to the best o6 my (our) knowledge; that I (we) am (are) the owner (s) o6 the properr ty deb ch i.bed in this .in6o4mation 6o4m, by viAtue o6 a waAAanty deed %econded in the 066ice o6 the County Reg-ibten o6 Deeds as Document No. ; and that I (We) pAuentey own the proposed 6-cte bon the sewage diapos s ys 'em (on I (we) have obtained an easement, to nun with the above deachibed pnopenty, bon the conatnucti.on o6 said system, and the same has been duty teemded in the 066.ice o6 the County Reg.iaten o6 Deeds, ab Document No. SIGMA OFD OWNER SIG URE OF CO-OWNER (IF APPLICABLE) DATE S GNED DATE SIGNED Violation Number Form- S T C - 101• PRE SANITARY PERMIT ISSUANCE PROCEDURE Location Section Township/Municipality Lot No. Blk. No. Subdivision ho `yI nokI .9- 4 IT 2~ N./ R 16 WI ) I n01 Cr~(sl)rlc C I I J- Procedure prior to sanitary permit issuance where a septic tank must be replaced during winter weather or other health emergency and soil evaluation or other sys- tem evaluation cannot be conducted. 1. Obtain assurance that the property owner is aware of further requirements for a system evaluation. 2. Obtain assurance that owner is aware that if system is found to be failing, it will be their responsibility to replace it with a code complying system. AFFIDAVIT TO BE SIGNED BY PERSON REQUESTING THE SANITARY PERMIT: the undersigned do hereb acknowledge that I am receiv a sanitary permit to re ICLC Q C ~C~t~l K without a soil and system e~~Iuu. u: ^ -Inclement weather or health emergency. Furthermore, I acknowledge that a soil and system evaluation will be conducted as weather permits and that if the system is then found to be failing as defined in Section I L H R 83.02 (18), Wisconsin Administrative Code, it will be replaced with one that complies with Chapter I L H R 83 of the Wisconsin Administrative Code. If temporary pumping is to be utilized for maintaining a newly installed septic tank, due to failure of the system, the tank shall be maintained by a licensed pumper in accordance with N R 113, Wisconsin Administrative Code. SIGNED DATE A copy of an affidavit in lieu of EH 115 along with the PLB 67 must be submitted to the Plumbing Bureau for purposes of fee reimbursement. 6E Signature pplicant Date _t Subscribed and sworn to before me STATE OF WISCONSIN This day of 19 SS. COUNTY OF _2. Notary ub ic, State of Wisconsin My Commission Expires: / 7 Q i 5 J ffi 9 h _W N 111 ~ r - 't -n Wl- at 0- mr, O l~►t .a.~,taia parraf `af 1,is,~ , 1 las . lac 'af/ ;~Maexi~liM • ~ Titre Piro . u Jill ` eti.es : ? lyK ~J, the S~ disoa~,iMd, ~ th~eratr~" ta' tbs: ~orttlt ,QwE, t>Nt' t~ td Sim ft 3i~r, 81 iwt +b to °N rise+d aae. 3 .U'sdre40=I* Or lass.. ~CM .ice 1t1~ , <ot' wos1tssea. All ksantaiw#na 90 st; a fi am) Op as* fal f~`Mr a 8 3/i s>w3 Ails ds MNWAW fo am* tb ttsw~o .at as ~s idtews:' 10 Mob cojoeb*Sft.". Ss~t~lb~ic 1, 1~f78,~rtLfG ti~1~, swd "Pia ter- x io, ?Mil MO4 s ~oootwd `17 tie Vss#or 1* Nl NNW~ fir Offir- hM ao- tow" men", i*Owsft ~Mt -spwtY to"so~16 ;tats of VABOord* Caul ty Of St. Croix I hereby SoMfY dwt "1°~ is o fug. true and coned GWY o the doou oat end of reoord In OV Win compared by M9- March 30 19~~ - . James O'Connell 1J@Ippt Deputy <re,rretatle. of +i~tai! td , t .die r a•w•~. iM venom ii"" AN ' 0040 cattiw,~ 66te mar tow *004 to b~ cntttrti~tttts en'tir4s ~rgi~tl+, s _~M orrallitiew,and fir" =to 100" ot -O*MprrKY tea reow liens +~ypscia , pith* erlq~ atT[ Stn ir, cdimseces a e 4smiolm afEectiad the property. t € Atc mess that in rats the puchase p •ith inleied 'and other 'et yot ft thms wo i the above yseified, ' . at of ' MarrantY Des1,'ta fart ttitipM, oi:Nrrtti N~~Y; ft~ and cle ; t> . sa~atet 7 tltr act dafaak of piatcutiet, "d rrc+pt: ~ bs tWt tjoe is et tbo`erssonce and in c of .defatlft in the ""tom of ~i . 4 Vof `atgr of the emwitcoven or proudses, of isurc9tarset, to z- # d dart:, then. Veadot- #ay, at vendor's optiott, declaim the, cost lied.: 'a the ads:} paid by P 6eaeradrrr' uk*ssft u traAw of sai vtti~les and as llquidr~sd damages f~,f the faikrMe. pJ tt! w i r 'tTpid aithoat notlea hate the right:o# rrentry; Sr. at the, option . V dsr +t s b1409 b aly ed, 40 whole Mount of aid~pr~t~pt~cClpnt Awl and raMlr, is cage aate~i optisa *ban bereirised, the unpaid piinci aztid retest tftetlter teieM banMa bests pud by itpsfittr,~is bami sow. tiis~ed frith inters t on :such disbiuseatents trt th ve a is p suit at loin, at by ft vkldeure of 'acs contract tr"q'thrs same manner arts if the *b* of u " ,rs ijle 0" alias s~ wcb,deft iilt~ocewred. and the ladafDtedness shall embrace, with unpaw1sitrf restedy b ft}Iraf e any so frith stest sr afore' aid. Incase of legal proceedings to enforc r or t~9Et, , 1iteIMdied.teasctb.. attorney's fees, shall to added to the priacrpi3 becomt !lures caso of jadO"N- aitsll be irtetuded therstr.. 5 ? s act;1R4MsM Ujpinfpt or dutlag the psdattey of any aeti6rt of foreclosure of;th itoo" _ y.. gy,~'A 'crate ser 6f `tbe Property. isclud zi homestead interest, to collect the rents, ' 'property, during tMs 008"y of such action, and such rents; issues.-and - profits urban w appUed_se the coon shall direct. ,z Ail "a ms of this Contract shalt be finding upoh and inure to the benefits, a# the heirs. herd ~ ""d as" of.Venrtor and Puf'ehwwr:~tlf not an owner of"#Mi I pert] the "Use'o( tl~enAoe # wt~. ri=h:s in the subject Property and agrees to join in the execution of thw, e ns bi`eitn to release homestead is fulfllpettt hereof.) nand this - l: _ tsar of _ - J..~ Y 71 SEAL) , .:e low ( 3 w s" F, Leviw Cahill 11 - &AALI g ~.li (mil (SEAL) y~~ M ry • ` Li n Cat, AUTHEilTICATIOM ACl(iNOwLI OD# E ttathoatiest this day of STATE OF WISCONSIN PIERCE 4b` peraonelly came bef6re arse, ,,,,_Juiv 1978 ' ffm bill! StOt SI11I` OF VISCOMM ir hill- Katz Z. "to x ` aatbetisWAy 'Cis;1IMt +1t tla#tart".lry r-~ tY at lam-' y H z N H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT c St. Croix County z d a H ROUTE/BOX NUMBERa C~ Fire Number .CITY/STATE ZIP PROPERTY LOCATION:(, Section ✓ , T N, R--1-8W. Town of 1 /4'&'c Klmli6l , St. Croix County, Subdivision . Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. I St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 . E I/WE, the undersigned, have read the above requirements and agree (A to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- a ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED u,"17 'A DATE St. Croix County Zoning Office P.O. Box 98" Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 THOMAS WANG Owner: JOHN REIS 1009 1/2 WEST" MAPLE ROUTE 2 RIVER FALLS WI 54022 RIVER FALLS WI 54022 RE: Plan. Number: 87-03027-5 Date Approved: May 20, 1987 Gallons Per Day: 450 Date Received: May 13, 1987 Project Name: REIS, JOHN RESIDENCE Location: NW,NW,26,28,18W Town of KINNICKINNIC County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145-, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to constructiori. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbin has reviewed these plans. for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section IL.HR 82 for general plumbing or in Chapters 50--64 of the Wisconsin Administrative node. This appproval is for the following compoanents only: - REP1~ MOUND Inquiries concerning this approval may be made by calling (608) 266-6952. Si ly, C 0, x2~~ ROMAN A. KAMINISKI Bureau of Plumbing Safety and Buildings Division PPP02-6/0009w/20 cc-: JOHN REIS ____Private Sewage Consultant County UW-SSWMP ~ Plumbing Consultant Owner Plumber Environmental Health DI LH R-SBD-6423 (N. 04/81) EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS .10USTRY, DIVISION 413OR AND PERCOLATION TESTS (115 P.O. BOX 7969 UMAN RELATIONS \ -MADISON, WI 53707 (H63.09(1) & Chapter 145.045) )CATION: SECTION: TOWNS NICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: WO /TQ"/R/9 E (2():w I - ::::::::j OUNT OWNER' BUYER' NAME: T L ADDRESS: 9 -f~- ly. I 11) _1 P n I Ag //f3 >E DATES OBSERVATIONS MADE NO. BEDRMS: COMMERCIAL DES RIPTION: PR F L E TIONS: 7A ESTS: Residence 3 ❑New 5dReplace a C~ t7 o 3 0 / 0 ATING: S= Site suitable for system U= Site unsuitable for system )NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RE OMMEN ED SYSTEM: (optional) ❑s SU ®s ❑u ❑s NU ❑S ®U ❑S ®u A/oah~ Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ider s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS )RING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH )MBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) D o 4 3.Dd 60 By /hp~ Az ,50 CYL 171fte S CD>" ~?.~o W4xe6F:ne S dray, hij) Lolrast 1` deft ell I a D~ SAD S~,Jr' b S'D~, ~tT H Avl go au' f tn~ M xe Iro-% I el -2 g R % w 't-c n,,o LO fiS D.x Sa ra~ - t r. 5 p 3.,J0 .56 L', ltt h e . S !54 J (A S1 , a elk) Z nI-° PERCOLATION TESTS 5'ar4d w~►'~ 6 5. TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCH S RATE MINUTES _IMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 RI D PER1003 PER INCH 3 50 D 3P 3 3 6'> XP T- ' JT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- tal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent an$slloope. JiTEM ELEVATION 16a.,') 9,7030 2 T- - lea t tic. t4 LU) 1-1 f4 r d 1 he undersigned, hereby certify that the soil tests reported on his form were made by me in accord with the procedures and methods specified in the Wisconsin ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ME (print : TESTS WERE MPL TED ON: 310 ~Z )DRESS: r , uer I rill a 7~ CERTIFojC I'N MBER: PHONE NUMBER IoQtional}: a CST S UR(E~/:1 tr', O S OiTr ;TRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. L' HR-SBD-6395 (R. 02/82) OVER - Re-is -T 2. S 1\1 'R I a C(0 A Co • W 1 3 bo. VA 6y"'L.Z t 30 ° 1000 63 31 150 06-1 10 0", o, ug lpoy V CIO W L) p SOS 870302'7 Page - Of _ Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil F 3 E D % Slope Bad Off- 2 2 (Force Main Plowed Aggregate From Pump Layer D Cross Section Of A Mound System Using E -~2 A Bed For The Absorption Area F 5 i G Signed: A_$Ft. H 1.5 ;l Il B Ft. License Number: Ft. Date: a ~ J q Ft. NSF {axed' i"`;M K I U Ft. Alternate P sttion L Ft. 0302 h o k nn qq W Ft. eta 13~fi , _iQpl QF ' ~ S Observation Pipe J ~COP` r K - -------•01 A W L-------------- ~------1--------------- I Force Main From Pump Distribution Bed 0 f 2 • Pipe 2 2 I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page _ Of Perforated Pipe Detail 0 End View )Perforated End Cop PVC Pipe lc~ or,o ae~o Holes Located On Bottom, S Are Equally Spaced X\~ / Q S PVC Force Mai • 1 t ~ From Pump P PVC sir V < ,r f r if ~U" / Manifold Pipe p'✓a :-r' i```'` AfT lion Of Diatr~pe but,an Al to q Pi ikf t, JS L: i F oin From Pump Lost Hot* Should Be Ot NI n Neat To End Cop lokli End Cop Distribution Pipe P 8703027 R S 32 x 30 Y ZI Signed: Hole Diameter Inch License Number: Lateral to I_ Inch(es) a Manifold 2. Inches Date: Force Main At Inches PAGE OF PUMP CHAMBER CROSS SECTION AUD SPECIFICATIOUS' VENT CAP VENT ►1P1; APPROVED LocKlNl: ! WEATHER PR001~ MA HOLE COVER I L,S' FROM DOOR. JUNCTIOAI sOK W~WAfW 'AnkiDOW OR FRCSH IL M111. I AIR INTAKE GRADE _ N~MIN. av. IvAlu. COWOUIT ~ WAIN, . PROVIDE I IIJLET AiRTI6HT SEAL I X11 I V 40PROVLD JOIN A APPROVED Jolwtrs ~dr~ I ICI/ca. PIPC ° , W/C.I. PIPE ~ ~xTtIJD1Nr. ` r " r NS ( 1 ALARM EXTEUDIWCr 3 • 4~. ti " I 1 ONTO SOLID SOIL ibUT0 SOLID SOIL p l 0 ~ 44, F,~ r to I 1 LI' SJ`4 ~1i~Ui, I OIJ X14 { ` aCk 1 FTp~ppR~F:~t N 1f`y~/Ar~j`BUMP-~ '_J p`~OFF O ~V COUCRETE DLOCK s TM~w. ISER EXIT PERMITfcD OULU IF TANK MAIJUFACTURCR HAS SUCH APPROVAL 1 APPltnwt.% SPC CI FICATIOAIS SEPTIC E OOSC nn ? TANK MAIJUFACTURCR: M I,. 1M ~ IJUMOER OF DOSES: PER DAIS TAIJK 51ZE: GALLONS DOSE VOLUME I3,3` + ISO 3t, INCLUDING BACKFLOW: 0!03 GM.I.Olu3 LA ARM1 MAUUFACTUK&R: t- nn'' ,75 -t Q, Js MODEL NUMBER: CAPACITIES: A? WCHES OR 3S GALLOu3 SWITCH TyPR: A 13: INCHES OR GALLONS PUMP MAIJUFAGTURcc Coml!Y14 ,(,4 GALLONS MODEL IJUMBCR: WF_ c) 3 Do 2 INCHES OR I SOO GALLONS I SWITCH TYPE: MOTC', PUMP. AND ALARM ARE TO OL i MINIMUM DISCHARGE RATE PM INSTALLED OIJ SEPARATE CIRCUITS 9!. { VERTICAL DIFFERENCE BETWEEU PUMP OFF AIJO DISTRIBUTION PIPE.. 10 FEET ♦ MIIJIMUM NETWORK SUPPLY PRESSURE ...........?_`c'J~~. FECT 13 ' 3 / v' 0o1LFRICT101J FACTOR. .FEET ♦ .i. FEET OF i'ORCE MAIN X -27 FX . TOTAL OtIUAMIC HEAD FEET IIJTERNAL, DI IJSIONS Of TAUK: LENGTH --;WIDTH --...;LIQUID DEPTH F . ~;7 i' SIGIJED: 11[EI,JSE NUMBER: e~3 r DATE: Bulletin CUM July 8, 1983 • For Homes G ULD • Farms S • Trailer courts Model 3885 • Motels o (Supersedes Model 3870) • Schools • ' Submersible Hospitals t Pump Effluent Pumps ENluen Industry • Effluent Systems Pump Specifications anywhere effluent Solids Handling Capability to 3/4". or drainage must be Discharge Size 2" NPT. disposed of quickly Semi-Open Impeller quietly and efficiently. 3 vane design, threaded on shaft. Three phase units use impeller locknut to prevent accidental back-off. Pump out vanes on backside of impeller for protection of mechanical seal. Casing Volute type for maximum efficiency. Heavy-Duty Solids Handlin Stainless Steel Fasteners 9 Series 300 stainless steel for corrosion Dependable Capability t0 3/4" resistance. Mechanical Seal I _Cft Ceramic vs. Carbon sealing faces, stainless steel I i spring and Buna N elastomers. Maximum Temperature 1/3, 1/2H.P. 60 Hz 160°F. Capable of Running Dry Single Phase 115, 230 Volt. without damage to components. Motor Specifications 1/2, 3/4, 1, 11/2 H.P. 60 Hz Motor Fully Submerged Sln le Phase 230 Volt. Three i in high grade turbine oil for permanent lubrica- g i tion of bearings and mechanical seal and Phase 208-230, 460 Volt. efficient heat dissipation. Motor sealed from environment by rugged cast iron enclosure. Bearings - Heavy-duty all ball bearing construction. Stainless Steel Shaft i® ® Series 300 stainless steel for corrosion resistance. Threaded shaft. $70 3 0 2 7 Single Phase Units 90 All single phase units have built-in thermal overload protection with automatic reset. 80 Three Phase Units Overload protection in starter unit. 208-230 or 460 volts. Threaded shaft 60 Hz operation. F 70 W Power Cord W Water and oil resistant. Epoxy seal on motor end 0 60 acts as a secondary moisture barrier in case of Q damage to outer jacketing. Corrosion resistant Z 50 gland nut. U Single Phase Units Q 40 N.P. models equipped with 15' of 16/3 } SJTO with 3-prong grounding plug. 1, 1'.2 H.P. 0 30 models equipped with 15' of 14/3 STO power cord. O 20 SPECIFICATIONS ARE SUBJECT TO CHANGE 10 WITHOUT NOTICE. 0 0 10 20 30 40 50 60 70 80 90 100 110 120 r^ GOU LDS PUMPS, INC. GALLONS PER MINUTE lJ SENECA FALLS NEW YORK 13148 to TX N t,) h14S sa filar e a5 0 -'ah 1 f rec"en't Dr ell ~e ~S J - w ~ ~ ~ 7' SJJ ' t74' k'a Violation Number Form - S T C - 101. PRE SANITARY PERMIT ISSUANCE PROCEDURE Location Section Township Municipality Lot No. Blk. No. Subdivision h~ ~,J_ W n ~ ~4 IT 2b N R1$ ~If)r) IC~~Shn~ C' Procedure prior to sanitary permit issuance where a septic tank must be replaced., during winter weather or other health emergency and soil evaluation or other sys- tem evaluation cannot be conducted. 1. Obtain assurance that the property owner is aware of further requirements for a system evaluation. 2. Obtain assurance that owner is aware that if system is found to be failing, it will be their responsibility to replace it with a code complying system. AFFIDAVIT TO BE SIGNED BY PERSON REQUESTING THE SANITARY PERMIT: the undersigned do here=acknowledge hat I am receiv a sanitary permit to Y_ IQc e S k without a soil and system inclement weather or health emergency. Furthermore, I acknowledge that a soil and system evaluation will be conducted as weather permits and that if the system is then found to be failing as defined in Section I L H R 83.02 (18), Wisconsin Administrative Code, it will be replaced with one that complies with Chapter I L H R 83 of the Wisconsin Administrative Code. If temporary pumping is to be utilized for maintaining a newly installed septic tank, due to failure of the system, the tank shall be maintained by a licensed pumper in accordance with N R 113, Wisconsin Administrative Code. SIGNED DATE A copy of an affidavit in lieu of EH 115 along with the PLB 67 must be submitted to the Plumbing Bureau for purposes of fee reimbursement. Signature pplicant Date Subscribed and sworn to"before me STATE OF WISCONSIN This _JZ day of 19 SS. COUNTY OF f d~~ Notary ub ic, State of Wisconsin My Commission Expires: f ,S r S. ST. CROIX COUNTY , WISCONSIN M" ' ZONING OFFICE 796-2239 (HAMMOND) r..- 425-8363 (RIVER FALLS) HAMMOND, WI 54015 April 10, 1987 Division of Safety and Plumbing Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the John Reis property located in the NW 1/4 of the NW 1/4 of Section 26, T28N-R18W, Town of Kinnickinnic, St. Croix Couty, revealed suitable soils at a depth of 3 feet, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, T6na3 /(-c_ Thomas C. Nelson Zoning Administrator rc WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 79699 MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NW 1/4, Nw 1/4, Sec. 26 , T 28 N, R 18 TLTM W Town 5yeXI45fiWq Kinnickinnic Street Address Lot No. Block Subdivision Landowner's Name: John Reis The application for this site is for: ® new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: H to have one of the first five approvals guaranteed for this year. This is number 59 - 03 - 8 of those applications. (Use one of the first five quota num ersissueT-Fo-you.) [ one of the applications needing a quota number. The quota number assigned to this application is - - ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. F.Ifor an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. [J for an application on file prior to February 1, 1980. [_]for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson $i re County Official Title Zoning Administrator, St. Croix County Date April 13, 1987 DILHR-SBD-6158 (R 12/82) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 `f APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/Municipality: NW 14 NW kL S 26 IT _28 N/R 18 V1 W Kinnickinnic Street Address: Subdivision: County: St. Croix Landowners Name: Mailing Address: John Reis I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: